MP particpates in oppostion day debate on family GP services

Dr. Howard Stoate: The hon. Gentleman is making an intelligent point, but I have to say that I disagree with him on a number of issues. Certainly in my area, the availability of alternative community-based clinics has made a radical difference to GP referral patterns—hugely to the benefit of patients and patient satisfaction. In my practice, we do regular surveys of patient satisfaction and we have seen significant increased satisfaction as a result of patients being able to see medical people much closer to their homes and much more focused on their GP practice. In many cases, they receive care and treatment from people they personally know, which has to be an advantage. I accept that in other areas it might not be working as well, but the model itself seems to work very well.

Dr. Stoate: I thank the hon. Gentleman for giving way to me again. He is being very generous with his time. Perhaps I can help him. I have a letter from the commissioning lead for one of the primary care trust consortiums in my constituency, who says precisely the same about the need for piloting. He writes:     

“The intentions of the bids are to encourage a range of pilots that will explore the potential and flexibility of the concept.”

Pilots could, he says, be

      “existing health facilities which could be adapted or expanded... on-going developments”

or any other combination that local people decided was good for their area.

I do not understand where the hon. Gentleman is coming from when he says that there is no flexibility and no ability to pilot. That letter makes it entirely clear that the flexibility exists. [Interruption.] 

Dr. Stoate: I can help the hon. Lady on that point. One thing that polyclinics will do, for example, is to be open 12 hours a day, seven days a week. Virtually no GP practices are open for such hours. Secondly, polyclinics will provide services such as radiography, blood testing, ECGs and all sorts of facilities that are not available in the vast majority of GP practices—nor are they likely to be. Polyclinics are a model that will, we hope, keep patients away from acute hospitals and prevent long queues forming in accident and emergency made up of people who have no need to be there. They will enable those people to be looked after in a much more comfortable setting much closer to their home. On the transport issue raised by the hon. Lady, people will travel on average far shorter distances to reach such services than they have to under the district general hospital model.

Howard Stoate: First, may I apologise to you, Mr. Deputy Speaker, for not being in my place at the start of the debate? I had a meeting with the Prime Minister, but one of the issues that I raised with him was the proposal on polyclinics, so at least that was relevant to this discussion.

As many hon. Members will know, I am a practising GP, something that I hope will enable me to make a constructive contribution. It will be of no surprise to the House if I say that I speak to an awful lot of GPs around the country. Many of them are concerned about what the polyclinic model might lead to, and worried about how it might affect their practices and patients. I therefore think that it will help the House if I set out what I see as the vision for this type of health care.

I envisage a mechanism whereby people can be treated far closer to their own homes, with far less reliance on public transport, far shorter queues and much less reliance on accident and emergency departments, which are often inappropriate places for people to go with many health care needs. They are often not seen by the most appropriate person in the department, and in many cases it is not the nicest place to be. A and E departments simply become clogged up, which often gets in the way of the serious, life-saving work that they need to do. The last thing that they need is a group of patients coming to the A and E who would be far more appropriately treated by their GP practice, district nurse or pharmacist, in a setting that would be far better for their health care.

It is important to set out exactly what the polyclinic model is intended to do. The hon. Member for Mid-Bedfordshire (Mrs. Dorries) said that there is nothing that a polyclinic can provide that cannot be provided by a GP service. I am sorry that she is not currently in her place. The fact is that a polyclinic or such a model could offer a huge number of services that currently cannot be made available in GP services. An obvious example is X-rays. The hon. Member for South Cambridgeshire (Mr. Lansley) made the point that ECGs can be sent online. Of course they can, and of course blood tests can be taken in GP practices. However, it is much more difficult for a GP practice to have an X-ray or ultrasound department with the necessary scanning equipment and range of health care professionals. That is well beyond the scope of current general practice, and we need a radically new way of deciding how those facilities should be produced.

When I ask my patients what they want, they say that they want to be treated as near to their homes as possible, hopefully by people whom they know, trust and have had dealings with before. They do not want to go and sit in a crowded, noisy hospital among patients who clearly have far greater health needs and therefore should obviously take priority. The polyclinic model is a good example of how we can transform patient experience.

Another obvious example of why the system might work is that it is currently estimated that every time somebody walks into A and E, it costs the health service about £150. A GP consultation costs about £20, so we can immediately see that anybody who attends their GP surgery instead of going to A and E will lead to a dramatic saving in health care expenditure, which could therefore be targeted better than by spending it on A and E. Obviously a polyclinic would have extra fixed costs and there would be other services to consider, but it would still mean a significant cost saving compared with people going to A and E, and it would therefore leave far more money for investment in NHS services and for better use in patient care.

The NHS has moved on. Clinical practice is evolving all the time, and patients' expectations are changing. When I first entered general practice, people almost always had surgery as in-patients in hospital. They often stayed in hospital for several days, or even weeks. Now, 70 to 80 per cent. of all surgery is day surgery. The idea of relying on large, impersonal hospitals is a model that has outgrown its usefulness, and we need to move on to a much more flexible and modern approach. I believe that polyclinics, rather than diminish the range of services and choice, will increase it.

The myth that goes around that if a polyclinic is set up, patients will no longer have a choice of GP, is clearly rubbish. Under the patient choice directive, patients will be able to request a specific GP. Provided that that GP is on duty, that it is reasonable and that he or she has the available appointments, the patient will be able to specify that GP. It does not have to be impersonal. In fact, the model that I read out in an earlier intervention will, in many cases, be based around existing practices, which could be significantly extended or developed to add the extra services that are not currently available, albeit with extra funding and resourcing.

Another advantage of polyclinics is that they will allow GPs, acute specialists and other health professionals such as pharmacists to work together for the first time. General practice can often be isolating, and in small, isolated practices it is often quite difficult to have the mix of colleagues and clinical expertise that is required for personal and professional development.

I am aware that time is pressing on, so I do not wish to go on too long, but I wish briefly to quote Mr. Anthony McKeever, the chief executive of the care trust in Bexley, where my practice is situated. I wrote to him recently to ask what the PCT's model of polyclinics was. He stated:

"We do not intend to create polyclinics on the assumption that 'one size would fit all'...A couple of local practices have indicated that they would like actively to explore the possibilities of providing a more integrated care landscape...So, there will be plenty of opportunity to avoid the pitfalls which some anticipate...Certainly, however, the GPs I spoke to direct recognised that the development of primary care 'hubs' or polyclinics could be achieved without damaging and unintended consequences."

As far as I can see, that is the chief executive of a PCT being sensible and pragmatic and understanding that flexibility is perfectly acceptable under the Government's plans, and who actively wishes to work with local GP practices to ensure that what actually happens is a huge improvement in patient care outcomes. Hopefully, that is what we are all aiming for.

To read the full debate, please visit http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm080423/debtext/80423-0003.htm#08042357001375